* 1. Student Name:

* 2. Student Phone:

* 3. Student Email:

4. What year are you?

* 5. What is your major?

* 6. Discuss your interest in entrepreneurship:

* 7. Have you already launched a startup?

8. If yes, tell us about it. If no, what idea(s) would you share with your mentor?

* 9. What are you expectations for the mentor program?

10. What are the top 3 things you seek to learn from a mentor?

11. You will need to drive to meet your mentor, do you have reliable transportation?

12. Are you a member of the Chapman EClub (Entrepreneur Club)?